Cell Biology and Pathology, Exams of Nursing

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NURS 231 PATHOPHYS FINAL EXAM

A bodybuilder's muscles will display hyperplasia. - Correct Answer False

Barrett esophagus

is an example of dysplasia - Correct Answer false

hypertrophy is an increase in the size of an organ or tissue caused by an increase in the

number of cells - Correct Answer True

Lack of nerve stimulation can cause cells to atrophy - Correct Answer True

proportion of people with a disease who are positive for the disease - Correct

Answer sensitivity

how likely the same result will occur if repeated - Correct Answer reliability

how a tool measures what it is intended to measure - Correct Answer validity

people without the disease who are negative on a given test - Correct

Answer specificity

Which is NOT true of the cytoskeleton? - Correct Answer it includes peroxisomes

and proteasomes

Which of the following are true of the cell? Select all that apply. - Correct

Answer 1: Proteins carry out the functions of the cell membrane

2:Lysosomes are the digestive system of the cell 3:Microfilaments are thin, threadlike cytoplasmic structures

Which are true of the cell membrane? Select all that apply. - Correct Answer 1:

Controls the transport of materials from the outside fluids to within 2:Helps with the conduction of electrical currents in nerve and muscle cells 3: Aids in the regulation of cell growth and proliferation

Which are false of the mitochondria? Select all that apply. - Correct Answer 1:

They are found far from the site of energy consumption. 2:They control free radicals.

High blood pressure is an example of which of the following? - Correct

Answer pathophysiology

A patient complains of chest pain and an elevated blood pressure. What are these

examples of? - Correct Answer signs and symptoms

Which of the following is true of a test's sensitivity? - Correct Answer If negative,

it can safely be assumed that the person does not have a disease

Chemical agents (poison, alcohol) are examples of which of the following? - Correct

Answer Etiologic factors

Define tertiary prevention and give an example: - Correct Answer Tertiary

prevention occurs after a disease has been diagnosed and clinical intervention is needed to reduce complications or deterioration. One example is the use of certain medications one must take after a heart attack to help reduce the risk of a future event or death.

Compare and contrast the two types of gangrenous necrosis. - Correct Answer In

dry gangrene the affected tissue becomes dry and shrinks, the skin wrinkles, and its color changes to dark brown or black. The spread of dry gangrene is slow. It results from a cut off in arterial blood supply and is a form of coagulation necrosis. In wet gangrene, the affected area is cold, swollen, and pulseless. The skin is moist, black, and under tension. Blebs form on the surface, liquefaction occurs, and a foul odor is caused by bacterial action. The spread of tissue damage is rapid. Explain what necrosis is and give an example and description of one type of necrosis. -

Correct Answer necrosis is cell death to an organ or tissue with still being apart of

a living person. An example of this would be luiquefactive necrosis. this is when the cells die and the catalytic enzymes do not get destroyed after the cells death. This could cause necrosis

sunburn - Correct Answer radiation injury

obesity - Correct Answer nutritional imbalances

reactive oxygen species - Correct Answer free radical injury

low oxygen to tissues - Correct Answer hypoxic cell injury

fractures - Correct Answer physical agents

OTC drugs - Correct Answer Chemical injury

hypothermia - Correct Answer physical agents

radiation treatment - Correct Answer radiation injury

lead toxicity - Correct Answer chemical injury

bacteria - Correct Answer biologic agents

List the 4 types of tissue found in the body. Pick 2 and give a description and example

of each. - Correct Answer Epithelial tissue- covers the body's outer surface, it is

avascular and gets its o2 from the capillaries found in the neighboring connective tissues, and example of this is simple squamous tissue which means one layer of thin cells. Muscular tissue Nervous tissue- is found all throughout the body, helps with communication between tissues and the central nervous system. it aids in the functions of the body due to internal and external stimuli, helps with movement, and electrical signaling. neurons are an example of this, they aid in communicating to other cells in the body, they are held and supported by glial cells. Connective tissue What term means "cell eating" and engulfs and then kills microorganisms or other

particulate matter? - Correct Answer Phagocytosis

What is the term to describe when cells use energy to move ions against an electrical or

chemical gradient? - Correct Answer Active transport

Give one function of a membrane potential: - Correct Answer Generate nerve

impulse, muscle contractions, or cause hormone secretion What is the term that best describes the following process? A transport protein aiding a lipid insoluble or large molecule across the cell membrane

that would otherwise not be able to pass through on its own. - Correct

Answer facilitated diffusion

Blood tests for tumor markers can make a diagnosis of cancer. Why or why not? -

Correct Answer False, only tissue can diagnose. Tumor markers are helpful to

assess response to therapy or reoccurrence.

Tissue biopsy is of critical importance in what role? - Correct Answer Diagnosing

the correct cancer and histology.

Explain the TNM system: - Correct Answer T is the size and local spread of the

primary tumor. N is the involvement of the regional lymph nodes. M is the extent of the metastatic involvement.

List two signs or symptoms a patient may present with that might indicate a cancer

diagnosis: - Correct Answer fatigue, anemia

What are two systemic manifestations of cancer exhibited by cancer patients? -

Correct Answer Weight loss, wasting of body fat and muscle tissue, weakness,

anorexia, and anemia, fatigue, sleep disturbances

When would surgery be appropriate in the treatment of cancer? - Correct

Answer if it is a solid tumor and has clear margins

Most chemotherapeutic drugs cause pancytopenia due to bone marrow suppression.

What are the 3 possible adverse outcomes of this? - Correct Answer loss of

RBCs, WBCs, and platelets, anemia, and hemolysis Cell proliferation is the process in which proliferating cells become more specialized cell

types. - Correct Answer false

Cell differentiation is the process in which proliferating cells become more specialized cell types.

Correct! - Correct Answer True

What are two important properties that stem cells possess? - Correct

Answer Potency and self-renewal

Which of the following are most likely to have arisen from an adult stem cell? -

Correct Answer Epithelial

Define polyp. Are they benign or malignant? - Correct Answer A polyp is a growth

that projects from a mucosal surface, such as the intestine. A polyp can be benign or malignant

What are normal genes called that become cancer-causing if mutated? - Correct

Answer protooncogenes

What type of gene is involved in repairing damaged DNA? - Correct

Answer Tumor suppressor gene

A 40-year-old woman has experienced heavy menstrual bleeding. She was told she has a uterine tumor called a leiomyoma. She is worried she has cancer. What do you tell

her? Explain at least 2 differences between a benign and malignant tumor - Correct

Answer i would explain to her that it is a benign tumor, and that there is nothing to

worry about

1 benign tumors grow by expansion and are usually encapsulated; while malignant tumors grow by invading and taking over tissue 2: benign tissue is well differentiated and looks like the tissue of origin, while malignant cells are undifferentiated and are atypical and do not look like the tissues of origin. A 50-year-old woman was diagnosed with breast cancer from tissue biopsy following her diagnostic mammography. They are determining if it has spread to the lymph nodes. (1) Explain what the sentinel node is. (2) How will they determine if it has spread to the lymph system? (3) Would a detailed family history of disease be important to obtain? -

Correct Answer The sentinel node is the first lymph node to which the primary

tumor drains. The extent of disease may be determined through lymphatic mapping and sentinel lymph node biopsy. A radioactive tracer and/or blue dye is injected into the tumor to determine the first lymph node. This lymph node is examined for the presence of cancer cells. Yes, heredity can be a strong risk factor for cancer in some families. Malignant tumors have which of the following characteristics? Select all that apply -

Correct Answer Variable rate of growth &

Spreads by metastasis What are molecular and cellular mechanisms in genes that increase susceptibility to

cancer? Select all that apply. - Correct Answer 1:Lack of cellular senescence

2:Angiogenesis 3:Mutations in growth factor signaling pathways

List 4 of the 7 risk factors linked to cancer as stated in the module. - Correct

Answer hereditary, obesity, environmental agents, immunological mechanisms

1. ______ is a systemic treatment that enables drugs to reach the site of the tumor as

well as other distant sites. - Correct Answer chemotherapy

The profound weight loss and wasting of fat and tissue that accompany cancer is known

as _______. - Correct Answer wasting or Cancer anorexia cachexia syndrome

Which of the following is not a risk factor for developing cancer? - Correct

Answer Sunscreen

All of the following viral agents are correctly paired with the associated lesion except: -

Correct Answer Epstein-Barr virus: carcinoma of the cervix

List one example of screening for each method: observation, palpation, and lab

test/procedure: - Correct Answer observation: looking at the skin

palpation: palpating breast for abnormal masses Lab: pap smear swabbing for cervical cancer

Explain the challenges of diagnosing autoimmune disorders. - Correct

Answer There are over 80 identified, many with overlapping presentations. Many

manifestations are nonspecific and are seen in other non-autoimmune diseases. Blood testing isn't perfect either, as some tests are more generic and can be elevated in the presence of other diseases.

Which cell is the first responder to phagocytose a foreign invader? - Correct

Answer monocyte

What allows the lymphocyte to differentiate between self and foreign molecules? -

Correct Answer Major histocompatibility complex (MHC) molecule

T lymphocytes produce what type of immunity? - Correct Answer Cell-mediated

Which immunoglobulin passes immune factors from the mother to the fetus? -

Correct Answer IgG

Which cell type is an early responder and the most abundant in the body? - Correct

Answer Neutrophils

Which feature is NOT of adaptive immunity? - Correct Answer Epithelium is a

defense mechanism A 12-year-old female presents with itchy eyes, nasal congestion and drainage, and sneezing every spring when the pollen count is high. (1) Explain the immunologic mechanisms that are responsible for her symptoms. (2) What type(s) of treatment might

be used to relieve her symptoms? - Correct Answer 1) Mast cells, basophils, and

eosinophils play an important role in the development of type I reactions because they contain the chemical mediator histamine. A primary or initial-phase response is vasodilation, vascular leakage, and smooth muscle contraction. A secondary or late- phase response is characterized by more intense infiltration of tissues with eosinophils and other acute and chronic inflammatory cells, as well as tissue damage. (2) Antihistamines and intranasal corticosteroids are the mainstay of treatment.

A narrow, surgical-type wound is likely to heal by secondary intention. - Correct

Answer false

Which of the following is an incorrect pairing of a classic manifestation of acute

inflammation with its corresponding cause? - Correct Answer Dolor -

inflammatory cells infiltrating sensory nerves

B cells are primarily associated with humoral immunity. - Correct Answer true

T cells mature in the thymus and are active in cellular immunity. - Correct

Answer true

B lymphocytes normally produce antibodies against host tissues. - Correct

Answer false

Antibodies are also known as ______? - Correct Answer immunoglobulin

Which of the following hypersensitivity reactions can be treated with the administration

of epinephrine - Correct Answer type 1

Which cell is NOT part of the adaptive immune response? - Correct

Answer monocytes

Features of systemic lupus erythematosus include all of the following except -

Correct Answer Exophthalmos

What are the 2 factors that play a role in the development of autoimmune diseases? -

Correct Answer genetics and environmental factors

A 40-year-old man presents with cough and shortness of breath. After an H&P and chest films, it is determined he has pneumocystis carinii pneumonia (PCP). The provider does an HIV test, which is positive. Upon further testing, the man's CD4+ cell count is 100 cells/μL and his viral load is 250,000 copies/mL. (1) Why did the provider do an HIV test after the man was diagnosed with PCP? (2) What classification does this

man fall into based on his CD4+ count and symptomatology, and why - Correct

Answer (1) Opportunistic infections are those common organisms that do not

produce infection without impaired immune function. (2) The last phase, or AIDS illness, occurs when the CD4+ cell count falls to less than 200 cells/μL or exhibits an AIDS- defining illness. The risk of opportunistic infections and death increases significantly when the CD4+ cell count falls below 200 cells/μL.

Which process is NOT included in wound healing? - Correct Answer Acute-phase

response While labile and stable cells can regenerate themselves, _______ cells are unable to

undergo mitotic division. - Correct Answer Permanent cells

____ disorders occur when the immune system fails to differentiate self from non-self. -

Correct Answer autoimmune

The time between HIV infection and seroconversion is called what? - Correct

Answer the window period

A person with HIV is not infectious when they are asymptomatic. - Correct

Answer False

The T cells that display the host's MHC antigens and T-cell receptors for a nonself-

antigen are allowed to mature, a process termed negative selection. - Correct

Answer False

What cell mediator is the primary cause of vasodilation seen in acute inflammation? -

Correct Answer Histamine

The three stages of hemostasis include each of the following except: - Correct

Answer Vascular dilation

Which cell in the blood provides primary hemostasis - Correct Answer Platelets

Which of the following medications would decrease a person's risk for clotting? Select

all that apply. - Correct Answer 1: Heparin

2: warfarin 3: lovenox

Which of the following is a hypercoagulable state? Select all that apply. - Correct

Answer congestive heart failure, smoking, and post-surgical state

Which of the following are TRUE of hemophilia A? Select all that apply. - Correct

Answer Spontaneous joint bleeding can occur,

The PTT is increased

Which is NOT included in the three principles of blood flow? - Correct

Answer Compliance

Which of the following does NOT affect the heart's ability to increase its output? -

Correct Answer Cardiac reserve

Which of the following is true of the renin-angiotensin-aldosterone system? - Correct

Answer Angiotensin II increases sodium reabsorption in the kidney by stimulating the

secretion of aldosterone Which of the following does NOT lead to an increased risk for DVT? Select all that

apply. - Correct Answer Non-smoker

Which of the following is NOT associated with iron deficiency anemia? - Correct

Answer Normocytic

What are the two major causes of microcytic anemias? - Correct Answer Iron

deficiency anemia, Thalassemias Which of the following are potential causes of a sickle crisis in sickle cell anemia?

Select all that apply. - Correct Answer 1: dehydration

2: cold exposure 3: physical exertion The patient is found to be a severely malnourished alcoholic. The most likely cause of

his anemia is: - Correct Answer Folate deficiency

Which of the following is NOT true of vitamin B12 deficiency anemia? - Correct

Answer Dietary deficiencies are common

Each of the following are risk factors for secondary hyperlipidemia except? - Correct

Answer Autosomal dominant disorder of LDL receptor

Lifestyle changes to treat hyperlipidemia include each of the following except: -

Correct Answer Increase red meat consumption

Risk factors for atherosclerosis include each of the following except: - Correct

Answer Female gender (pre-menopause)

1. The three major determinants of myocardial oxygen demand (MVO2) include each of

the following except: - Correct Answer a. Diastolic pressure

2. ______ is the most important factor in myocardial oxygen demand. As this increases,

myocardial oxygen consumption or demand also increases. - Correct

Answer heart rate

3. What is the most common cause of cardiogenic shock? - Correct

Answer myocardial infarction

4. Which does NOT occur during cardiogenic shock? - Correct

Answer decreased systemic vascular resistance

Explain the differences in the pathophysiology, symptoms, and whether nitroglycerin and/or rest will relieve symptoms in stable angina, unstable angina, and myocardial

infarction. - Correct Answer stable angina is when you have angina with exertion,

usually will go away with nitro or rest unstable angia is wen you have angina without exetion and it will not go away with rest, its not very constant and very unstable, may ease woth nitro

Myocardial infarction is a heart attack, may include SOB, nausea, chest pain, numbness, or an abnormal EKG. this can easy with nitro but most likely the pt will be sent to the cath lab for catherization. Hypertension is often called "the silent killer." By the time symptoms of hypertension occur, the complications can affect the kidneys, heart, eyes, and blood vessels. What is

this term called? - Correct Answer target organ damage

. Left ventricular hypertrophy is a major risk factor for what other diseases? Name at

least 2. - Correct Answer coronary heart disease, cardiac dysrhythmias,

congestive heart failure, and sudden death. With increasing occlusion of the coronary vessel(s), the demands of the resting heart may become too great. When the patient experiences angina without exertion, or when the level of exertion necessary to cause anginal symptoms decreases, this is called

what? - Correct Answer Unstable angina

A 40-year-old woman is hospitalized with a chronic illness characterized by hepatomegaly, distended neck veins, and peripheral edema. Which of the following

disorders is the most likely cause of these findings? - Correct Answer Right heart

failure Right ventricular failure is commonly characterized by each of the following changes

except: - Correct Answer Pulmonary edema

Left ventricular failure is commonly characterized by each of the following except: -

Correct Answer Liver congestion

Which pharmacologic treatment of heart failure has a mechanism of action

characterized by excretion of fluid, reducing preload: - Correct Answer diuretic

The laboratory test that measures the volume of red cells in 100 mL of blood is _____. -

Correct Answer hematocrit

are a group of inherited disorders of hemoglobin synthesis common among

Mediterranean populations. - Correct Answer Thalassemias

The drug most commonly associated with inhibition of platelet aggregation is ______. -

Correct Answer aspirin

According to JNC 8 guidelines, what category does this patient's blood pressure fall into? What is hypertension a risk factor for? What lifestyle modifications would you suggest for them?

Name one medication therapy for hypertension and its mechanism of action. -

Correct Answer Hypertension stage 2

Atherosclerosis, CAD (MI), heart failure, stroke, peripheral artery disease Lose weight, exercise, decrease salt intake, decrease alcohol intake Diuretics, like thiazides, lower blood pressure by decreasing vascular volume; Even after forced expiration, a significant amount of air remains in the lungs. -

Correct Answer TRUE

Nearly all pulmonary emboli are thrombi arising from deep vein thrombosis in the upper

and lower extremities. - Correct Answer true

______ measures expiratory volume in a given time. - Correct Answer Forced

expiratory volume (FEV)

The _____ are the actual sites of gas exchange between the air and blood. - Correct

Answer alveoli

Intrapleural pressure is always negative in relation to alveolar pressure in a normal

inflated lung. - Correct Answer true

During inspiration, air is drawn into the lungs and the chest cavity is decreased. -

Correct Answer false

The diaphragm is the primary muscle of inspiration - Correct Answer true

Excess surface tension makes lung inflation harder. - Correct Answer True

Lung volumes can be measured using a ______. - Correct Answer spirometer

_____ is the flow of gases into and out of the alveoli of the lungs. - Correct

Answer Ventilation

Which of the following cells contribute to airway inflammation in asthma? Select all that

apply. - Correct Answer Eosinophils, mast cells, neutrophils, Leukotrienes, and

lymphocytes Alpha-1 antitrypsin deficiency is most likely seen in which disease process? -

Correct Answer Emphysema

Histologically, chronic bronchitis would exhibit each of the following except: - Correct

Answer Enlargement of the airspaces

Each of the following are TRUE of ARDS except: - Correct Answer Presents with

decreased respiratory rate A 30-year-old man is brought to the ER with a knife wound to the chest. On visual inspection, asymmetry of chest movement during inspiration, displacement of the trachea, and absence of breath sounds on the side of the wound are noted. His neck veins are distended, and his pulse is rapid and thready. What is your initial diagnosis?

What type of emergent treatment is necessary? - Correct Answer 1) tension

pneumothorax

2. chest tube When is the risk for obstructive atelectasis the greatest? What are strategies to

decrease the chance for developing atelectasis? - Correct Answer The risk of

obstructive atelectasis is increased following surgery. Anesthesia, pain and pain medications, and immobility promote retention of bronchial secretions. Patients are encouraged to frequently cough, deep breath, change positions, hydrate adequately, and ambulate early to prevent atelectasis. Explain why the oxygen flow rate for people with COPD is normally titrated to maintain

the arterial PO2 between 60 and 65 mm Hg. - Correct Answer Their medullary

respiratory center has adapted to the elevated CO2 levels and no longer responds to increases in PCO2. Therefore, a decrease in PO2 becomes the stimulus for respiration. If oxygen is given at too high of a rate, it suppresses the stimulus and the respiratory drive.

Each of the following can lead to atelectasis except: - Correct Answer Thrombus

Someone with COPD would exhibit each of the following characteristics except: -

Correct Answer Increased D-dimer levels

Ventilation - Correct Answer The flow of gases into and out of the alveoli of the

lungs

Perfusion - Correct Answer The flow of blood in the adjacent pulmonary

capillaries

Diffusion - Correct Answer The transfer of gases between the alveoli and the

pulmonary capillaries Each of the following disorders are correctly paired with related characteristics except: -

Correct Answer Atelectasis - decreased respiratory rate

A patient has experienced a seizure affecting the left temporal lobe. The family reports that the patient exhibited repetitive lip smacking and hand rubbing followed by a period

of great fear and insecurity. They have experienced which type of seizure? - Correct

Answer Focal seizure with impairment of consciousness or awareness

Voluntary tongue movements are controlled by which cranial nerve? - Correct

Answer CN XII.

You are seeing a patient with Parkinson's disease in your office. You feel a catch as you passively take their arm through flexion and extension. This is an example of what

physical manifestation of the disease? - Correct Answer Cogwheeling

Sleep spindles are characteristic of which stage of sleep? - Correct

Answer Stage 2

A person reports a generalized depressed mood, changes in appetite, and irritability that gets worse as the day goes on. They also report that they sleep more than 8 hours which is affecting their productivity. What type of depression are they experiencing? -

Correct Answer Atypical depression

Each of the following statements is true regarding the organization of the nervous

system except: - Correct Answer The CNS has an afferent and efferent division

Each of the following statements is true regarding Alzheimer's disease except: -

Correct Answer Neurofibrillary tangles are composed of deteriorating nerve

pieces that arrange themselves around a sticky protein core called amyloid beta (Aβ)

Each of the following are modifiable behaviors related to stroke except: - Correct

Answer Hypercholesteremia

Primary insomnia is characterized by each of the following except: - Correct

Answer Can also be called comorbid insomnia

What type of seizure occurs in 2 phases, involves a loss of consciousness, and lasts

approximately 60-90 seconds? - Correct Answer Tonic-clonic seizure

Sleep disturbances associated with narcolepsy include each of the following except: -

Correct Answer sleep apnea

Each of the following statements is true of Parkinson's disease except: - Correct

Answer It is characterized by an increase of dopaminergic neurons

Efferent neurons deliver _______ input from the CNS to the periphery. - Correct

Answer Motor

SRIs ________ the reuptake of serotonin at the presynaptic space. - Correct

Answer inhibit

_______ is sleep disordered breathing due to the brain not properly signaling the

respiratory muscles. - Correct Answer Central sleep apnea

________ utilizes electric impulses to inhibit or stop the abnormal nerve activity that causes tremor and other unwanted movement patterns associated with Parkinson's

disease. - Correct Answer Deep brain stimulation

Specialized ependymal cells that project into the ventricles and produce CSF are called

the ______. - Correct Answer Choroid plexus

Schwann cells produce myelin in the CNS. - Correct Answer False, Schwann

cells produce myelin in the PNS.

Alterations in the HPA axis have been linked to PTSD. - Correct Answer True

Vital signs increase during stage 1 of NREM sleep. - Correct Answer False, vital

signs decrease during stage 1 of NREM sleep. Someone in the early stages of Alzheimer's disease requires assistance for their

activities of daily living. - Correct Answer False, in the early stages of Alzheimer's

disease, individuals are still independent with their ADLs. Explain how a chemical synapse produces an excitatory or inhibitory signal. -

Correct Answer The presynaptic neuron will secrete neurotransmitters which

diffuse into the synaptic cleft and bind to excitatory or inhibitory receptors on the postsynaptic membrane eliciting an excitatory or inhibitory signal in one direction. You are babysitting a 7-year-old child with a known history of seizure activity. You notice they appear flushed and seem unresponsive. You ask if they are feeling alright and they stare at you blankly. After a few seconds they act as if nothing happened and return to play. Is this a generalized or focal seizure? Based upon this description, what

specific type of seizure did this individual experience? - Correct

Answer Generalized, Absence seizure

Compare and Contrast breathing patterns between NREM and REM sleep (include a

discussion on the specific stages of NREM sleep.) - Correct Answer In stages 1

and 2 NREM sleep as well as in REM sleep, breathing is irregular, and brief periods of apnea are often observed (approximately 5-15 seconds.) During stages 3 and 4 of deep sleep, breathing becomes regular.

A patient reports to the emergency department where you are working at 10 pm. They report that earlier in the day beginning at approximately 9 am they began to experience tingling in their right arm. They decided to ignore it thinking it was probably a result of all the gardening they did the day before. As the day went on, the tingling sensation got worse, and they started to have difficulty speaking. The patient's spouse reported that they were slurring their words. Past medical history includes a diagnosis of diabetes and hypercholesteremia. By the time they are evaluated, their symptoms start to subside. The tingling disappears and their speech returns to normal. What do you suspect this patient has experienced? What evidence is there to support that diagnosis? -

Correct Answer This patient has experienced a TIA. They have experienced

symptoms consistent with oxygen deprivation to the brain, however their symptoms subsided within 24 hours of their onset. A 75-year-old male is brought to the emergency department by their spouse at 8 pm. The spouse reports that they were cleaning up after dinner at approximately 6:30 pm, and she noticed that her husband's speech was very unclear. When she asked him what was going on, he said that he didn't know and that the entire right side of his face felt numb. She reports that he is very active, but he has a past medical history of atrial fibrillation. Based upon these symptoms and past medical history, what do you suspect this patient is experiencing? How would you confirm this diagnosis? What treatment

should be administered? Explain why you chose that treatment. - Correct

Answer This patient is more than likely experiencing an ischemic stroke. A CT scan

and MRI would be needed to determine if a clot was blocking blood flow to the brain tissue and to rule out a hemorrhagic stroke. If a clot is found, this patient should receive tPA drugs as they are within the 3-4.5 hour treatment window. You are seeing a patient in your office with a primary complaint of excessive daytime sleepiness. Their spouse reports that they snore loudly and often wake up gasping for air. What type of sleep disorder do you suspect they are experiencing (be specific)? What type of diagnostic work up needs to be done? Name one treatment option to

address this patient's symptoms. - Correct Answer This pt is experiencing

Moderate/ borderline severe Obstructive Sleep apnea, we need to see if he has any of the potential risk factors like large neck girth, obseity, male, etc. the pt needs to go under extensive sleep studies to confirm their OSA diagnosis. depending on the severity, life style changes can help with this apnea but a NCPAP machine or a mouth peice can be given to open the airways and help them not to collapse during the pts sleep.

The liver is responsible for each of the following EXCEPT: - Correct

Answer Helps with digestion of lipids

Complications of gallstones include each of the following EXCEPT: - Correct

Answer Cirrhosis

Treatments for gastroesophageal reflux include each of the following EXCEPT: -

Correct Answer Caffeinated beverages

Treatment of irritable bowel syndrome includes each of the following EXCEPT: -

Correct Answer Anti-diarrheal medication

Each of the following factors are associated with increased incidence of peptic ulcer

EXCEPT: - Correct Answer Dietary history

The most common complication of peptic ulcers is _____. - Correct

Answer Gastrointestinal bleeding

Each of the following are characteristics of ulcerative colitis EXCEPT: - Correct

Answer Granulomatous lesions

Each of the following are characteristics of Crohn disease EXCEPT: - Correct

Answer Bloody diarrhea

The process of digestion begins in the stomach and finishes in the large intestine. -

Correct Answer False

is the process of moving nutrients and other materials from the external environment of

the GI tract into the internal environment. - Correct Answer absorption

The double layer of peritoneum that holds the organs in place and stores fat is called

what? - Correct Answer mesentery

What type of cell secretes gastrin? - Correct Answer G cells

The amplitude and frequency of the slow waves is regulated by ______? - Correct

Answer Enteric nervous system

Activation of the parasympathetic nervous system increases the amplitude of the slow

waves. - Correct Answer True

is a linear chain of interconnecting neurons located between the circular and

longitudinal muscle layers, involved with GI motility? - Correct Answer Myenteric

(Auerbach) plexus

Food is converted in the stomach into a creamy mixture called? - Correct

Answer chyme

Which GI hormone has strong growth hormone-releasing activity and stimulates food

intake and digestive function? - Correct Answer Ghrelin

Which GI hormone inhibits gastric acid secretion? - Correct Answer Secretin

Anti-diarrheal medication can be used with all types of diarrhea. - Correct

Answer False

Constipation and a low fiber diet are a major risk factor for developing what disease? -

Correct Answer diverticulosis

Clinical manifestations of cirrhosis include each of the following EXCEPT: - Correct

Answer Pancreatitis

What is now the most common cause of chronic liver disease in the Western world? -

Correct Answer Nonalcoholic fatty liver disease (NAFLD)

A patient presents with right upper quadrant pain, that worsens after eating a fatty meal.

What would be the best imaging modality to evaluate their complaint? - Correct

Answer Abdominal ultrasound

Excessive red blood cell destruction would cause what type of jaundice? - Correct

Answer Prehepatic jaundice

Each of the following statements are true regarding control over the GFR except: -

Correct Answer The RAA responds when blood pressure rises above normal

limits.

Which of the following statements is false regarding ADH? - Correct

Answer Elevated levels of ADH will lead to dilute urine.

Cortical nephrons are characterized by the following except: - Correct

Answer They originate deep in the cortex

Excess accumulation of fluid within the interstitial compartment is characteristic of which

of the following fluid imbalances? - Correct Answer Edema

Reabsorption in the loop of Henle is characterized by the following except: - Correct

Answer Na+ and water are reabsorbed in equal proportions

Which of the following is/are true regarding acid-base balance? (mark all that apply) -

Correct Answer Acid-base balance refers to the balance of the concentration of

hydrogen ions (H+) in the blood,

Venous blood is characterized by a more acidic pH, A higher concentration of OH- ions will increase the pH of the blood Acute postinfectious glomerulonephritis is characterized by the following except: -

Correct Answer Associated with a poor prognosis as it often leads to CKD

Which of the following is characteristic of chronic transplant rejection? - Correct

Answer Involves humoral immunity

Which of the following is true of 1,25-dihydroxycholecalciferol? - Correct

Answer It is the active form of vitamin D, converted in the kidney

A patient is said to be in stage 4 kidney disease. What would you expect their GFR to

be? - Correct Answer A. 25 mL/min/1.73m

The following are true regarding tubular secretion except: - Correct Answer K+ is

secreted in the intercalated cells A decrease in Na+ reabsorption is achieved through the action of which of the

following? - Correct Answer Diuretics

In the nephron, the mass of capillaries surrounded by an epithelial capsule that opens

into a tubule is collectively referred to as the _______. - Correct Answer renal

corpuscle The hormone that is synthesized in the kidneys and regulates the differentiation of red

blood cells is _______. - Correct Answer erythropoietin

The enzyme ___________ causes CO2 to react reversibly with water to form carbonic

acid (H2CO3) to regulate blood pH. - Correct Answer carbonic anhydrase

A person who has a blood Mg2+ concentration of 1.2 mg/dL. Is considered to have

_______. - Correct Answer hypomagnesemia

_______ failure is caused by conditions that damage the structures within the kidney. -

Correct Answer Intrarenal

Angiotensin I is converted to angiotensin II in the kidneys. - Correct

Answer False, angiotensin I is converted to angiotensin II in the lungs.

One should take in at least 40-50 mEq/day of potassium through the diet or by

supplement. - Correct Answer true

Explain why renal flow is decreased with sympathetic activity. - Correct

Answer Sympathetic activity is referring to the sympathetic nervous system, Fight or

flight method. The arterioles in the renal fow respond to this and constrict to decrease renal flow to maintain homeostasis. Whether that would be; making sure enough minerals or water is being absorbed or released. A patient's plasma Ca2+ levels are 11.0 mg/dL. Given these levels, list a symptom affecting the GI tract they may experience and explain why it would be occurring. -

Correct Answer The patient has hypercalcemia. Constipation, nausea, and/or

vomiting may result secondary to a decrease in smooth muscle activity. A patient has a diagnosis of glomerular disease. Given what you know about the structural framework of the glomerular capillaries, what would be detected in this

patient's urine, and explain why this would happen. - Correct Answer Blood and

protein may be present in the urine. Spaces within the basement membrane of the glomerular capillaries, under normal circumstances prevent red blood cells and plasma proteins from passing through the glomerular membrane into the filtrate. The disease process would compromise this. A patient with chronic kidney disease must undergo dialysis treatments as they wait for transplantation. Give 1 reason peritoneal dialysis would be preferable to the patient over hemodialysis and 1 concern in choosing peritoneal dialysis over hemodialysis. -

Correct Answer Peritoneal dialysis can be done in the patient's home as opposed

to going to a dialysis clinic multiple times per week. A major concern of the utilization of peritoneal dialysis is the risk for infection at the catheter site. A patient presents to the emergency department with complaints of sharp pain that comes in waves in the upper lateral quadrant of the abdomen. Their skin is clammy, and they have been experiencing nausea and vomiting all day long. They have a history of UTIs. Urinalysis reveals that the pH of their urine is 7.8. A CT scan is ordered, and it reveals a stone 4 mm in diameter. What type of renal calculi do you suspect? What

treatment is needed? Explain your reasoning for both answers. - Correct

Answer since the urine is alkalidic, i suspect a magnesium ammonium phosphate

renal calculi. The stone is not large enough to have any surgical intervention, it can pass on it own. pain management would be given as well as antibiotics to treat any current or future UTIs. I chose this answer because If the stone is between 1-5 mm then it can pass on its own, the urine is alkilidic which points to the MAP renal calculi, as well as you have to treat and even pretreat the UTI so the pt is not at risk for an even worst infection due to the renal calculi. A patient presents in the emergency department with severe dehydration secondary to vomiting. The following are the results of their blood work: pH = 8.2, PCO2 = 39 mm, and HCO3- = 33 mEq/L. Based upon these results, what type of acid-base disorder are they experiencing? Is compensation occurring? Describe a treatment intervention for this disorder. Normal values are as follows: pH = 7.35-7.45, PCO2 = 35-45 mm, HCO3-

= 22-26 mEq/L. - Correct Answer The patient is in metabolic alkalosis. The

respiratory system is not compensating as PCO2 compensation falls within normal limits. Fluids are replaced with normal saline solution. A patient is in the ICU following open heart surgery. The patient was feeling well earlier in the day, but suddenly began to demonstrate signs of confusion and disorientation. Blood results reveal Na+ = 100 mEq/L. Based upon these symptoms and results of blood work, what electrolyte imbalance is this patient experiencing? What treatment is

indicated for this imbalance? - Correct Answer This patient is experiencing

euvolemic hypotonic hyponatremia. The administration of intravenous saline solution would be indicated to correct the sodium deficiency. Redistribution of body fat with round moon face, dorsal "buffalo hump," and relatively

thin extremities suggests which of the following: - Correct Answer Cushing

syndrome The following are common signs and symptoms of Cushing syndrome EXCEPT: -

Correct Answer Weight loss

Signs and symptoms of Addison's disease include each of the following EXCEPT: -

Correct Answer Hyperglycemia

Addison's disease is due to which of the following: - Correct Answer Adrenal

gland dysfunction An autocrine action occurs when a hormone exerts an action on the cells that released

them. - Correct Answer True

A paracrine hormone is a hormone that produces a biologic action on the cell that

released them. - Correct Answer False

Target cells must have receptors to recognize a hormone and translate the signal into a

cellular response. - Correct Answer True

Hormones travel through the bloodstream attached to transport carriers only. -

Correct Answer False

What is the source of the hormone that plays a major role in the maintenance of body

metabolism and growth and development in children? - Correct Answer Thyroid

The posterior pituitary releases which of the following hormones? Select all that apply. -

Correct Answer Oxytocin, ADH

Type 2 diabetes mellitus is associated with each of the following characteristics

EXCEPT: - Correct Answer Beta cell mass markedly reduced

Each of the following are characteristics of diabetes mellitus EXCEPT: - Correct

Answer Myxedema

Of all the people with diabetes, approximately 70% have type 2 diabetes. - Correct

Answer False

Gluconeogenesis, or glucose formation, is promoted by the alpha cells. - Correct

Answer True

Most hormones are controlled through positive feedback. - Correct Answer False

Those with prediabetes have an increased risk of atherosclerotic heart disease. -

Correct Answer True

Testing for diabetes should be done on everyone initially at age 60. - Correct

Answer False

A 45-year-old obese, sedentary male has recently been diagnosed with type 2 diabetes. What are 2 strategies to help him normalize his blood sugars? List 2 other macrovascular complications he is at risk for and how you would screen for them? -

Correct Answer (1) Diet, exercise, and weight loss may be all that they need to

control blood glucose levels. Even moderate weight loss of 5-10% of total body weight has been shown to improve glucose control. (2) Hypertension and hyperlipidemia - checking blood pressure and screening with a serum lipid panel. A diabetic's risk of macrovascular diseases is 2-4 times higher and the leading cause of death among diabetics (50-75%) is from a macrovascular disease. Name 3 of the 4

complications listed: - Correct Answer Peripheral vascular disease, coronary

artery disease, heart attack, and stroke

Hypothyroidism is caused by each of the following EXCEPT: - Correct

Answer Thyroid adenoma

A 40-year-old woman presents with amenorrhea and weight loss despite increased appetite. The history and physical exam show exophthalmos, tachycardia, and warm,

moist skin. Each of the following lab abnormalities are expected EXCEPT: - Correct

Answer Increased TSH

Your diabetic patient with neuropathy is at risk for developing a foot ulcer. How would

you instruct him to care for his feet? List at least 3. - Correct Answer Wear proper

fitting shoes, daily feet inspection to look for blisters, sores, or signs of infection. Avoid smoking, cold temperature, bare feet. ______ is defined as a blood glucose of <60 mg/dL, with associated cognitive

impairment. - Correct Answer Hypoglycemia

The risk factors for _____ _____ include hyperglycemia, hypertension, hyperlipidemia, obesity, altered platelet function, endothelial dysfunction, elevated fibrinogen levels, and

systemic inflammation. - Correct Answer Macrovascular complications / disease

___ ____ is diagnosed by hyperglycemia, low serum bicarbonate, and low pH, with

ketonemia and moderate ketonuria. - Correct Answer Diabetic ketoacidosis

(DKA)

Which oral antidiabetic drugs increase GLP-1 and GIP, which increase insulin release

and decrease glucagon levels. - Correct Answer DPP-4 inhibitors

Each of the following are true of gout except: - Correct Answer A serum uric acid

level greater than 6.8 mg/dL without symptoms leads to a diagnosis of gout Which of the following would a patient likely report if you suspect they have OA? -

Correct Answer Stiffness in the morning that resolves in less than 30 minutes

Which of the following are true regarding syndesmoses? (mark all that apply) -

Correct Answer They allow a small degree of movement between them,

They are separated by a fibrous disc Cortical bone receives its blood supply through the following means except? -

Correct Answer Diffusion through the endosteal surface of the bone and the

canaliculi

What is the recommended calcium intake for premenopausal women? - Correct

Answer 1000 mg. daily

Which of the following cells regulate bone growth through the secretion of growth

factors and tumor necrosis factor? - Correct Answer Osteoblasts

Which of the following contribute to joint destruction associated with OA? (mark all that

apply) - Correct Answer Damaged chondrocytes,

Interleukin -1beta, Tumor Necrosis Factor-Alpha, An imbalance of protease and protease inhibitors

A patient has low serum calcium levels. Which of the following is true given this

scenario? - Correct Answer PTH will increase renal reabsorption of calcium while

simultaneously increasing renal excretion of phosphate A diagnosis of gout is made through which of the following tests? (mark all that apply) -

Correct Answer Blood work to determine uric acid levels, Analysis of synovial

fluid, 24-hour urine specimen In the early stages of OA, structural changes would include which of the following?

(mark all that apply) - Correct Answer Edema in the cartilaginous matrix

Which of the following is false regarding the synovium? - Correct Answer The

synovium surrounds the margins of articulation and lines the articulating surfaces of the joint Senile Osteoporosis is characterized by which of the following? (mark all that apply) -

Correct Answer Fractures of the hip joint, A direct relationship between aging and

rate of bone loss A T-score compares the bone of the patient to that of a healthy 20-year-old adult. -

Correct Answer false; healthy 30 yr old

Haversian canals contain the nerve and blood supply for the osteon. - Correct

Answer true

Hyperuricemia may be a result of an underproduction of purines. - Correct

Answer false; it is an overproduction of purines

Prolonged immobilization can lead to structural joint changes associated with OA. -

Correct Answer true

If someone loses their balance when walking on uneven terrain, explain how tendons

and ligaments work to protect the joint and structures within it. - Correct

Answer The tendons and ligaments of joints serve in proprioception (the awareness

of ones' position in space or movement of the body). When these structures undergo stretch or torsional strain, these proprioceptive nerve fibers will cause a reflexive response to adjust the tension on the muscles (to maintain balance and not fall over) that support the joint protecting the capsule and other joint structures. A patient presents to the ER with severe pain in their right ankle. Blood tests reveal serum uric acid levels of 7.8 mg/dL. They are kept for observation and their 24-hr urine specimen reveals underexcretion of urate. Which phase of gout are they in? What is the

goal of your treatment given the phase they are in? - Correct Answer This patient

is in phase 2 of gout or acute gout arthritis. The goal of treatment is to manage symptoms and terminate the acute attack primarily through NSAIDS. Which of the following patients is at greater risk for developing osteoporosis and sustaining a fracture? Explain how you came to your conclusion. Patient A. is a 75-year- old white Caucasian male who has a history of a distal radius fractures at age 65. Patient B. is a 60- year-old African American female who is postmenopausal. She is

active and does not have a history of fractures. - Correct Answer Patient A is at

higher risk. Even though he is a male, he is advanced in age, white Caucasian, and sustained a fracture after the age of 50. Patient B is a postmenopausal female; however, she is active and of African American decent which is associated with high BMD and low rates of fracture. A 60-year-old, obese female works out of her home and rarely walks due to the sedentary nature of her job. Give 2 reasons why she is at increased risk for developing

OA. - Correct Answer She is a female over the age of 55; she is obese, and she

is relatively sedentary which contributes to the decreased nourishment of the joint that comes with weight bearing and range of motion. (*Note - student only needs to provide 2 reasons.) Compare and contrast the blood supply of cortical bone and cancellous bone. -

Correct Answer Cortical bone has a direct blood supply. Nutrient and Perforating

arteries form an anastomosis (collateral circulation) that circulates through the bone through the Haversian and Volkmann canals. Cancellous bone does not have a direct blood supply. It receives its blood supply through diffusion from the endosteal bone surface extending outward through the canaliculi. A 22-year-old competitive gymnast has experienced amenorrhea for the past 5 years. Her PCP is suspecting that she may have premature osteoporosis. Would you expect her RANKL levels to be high, normal, or low? Explain why her levels would be at this

level. - Correct Answer Her RANKL levels would be higher than normal.

Amenorrhea results in lower estrogen levels. Estrogen increases the production of OPG which inhibits RANKL. Lower estrogen levels would lead to lower OPG levels in turn increasing RANKL and osteoclast activity. A 68-year-old, white Caucasian female has a DEXA scan at the recommendation of her PCP. Her scan yielded a T-score of -2.6. Interpret the results of her DEXA scan. Develop a treatment plan giving a pharmacologic recommendation if applicable (be specific with name of supplement and/or class of drug), and a non-pharmacologic

recommendation. - Correct Answer This T-score indicates osteoporosis. This

patient should take a Calcium and Vitamin D supplement. In addition, she should be prescribed one of the following: Estrogen, SERMs, Bisphosphonates, or Calcitonin. She should also participate in regular weight bearing and resistive exercise being careful to choose activities that would not put her at increased risk for falling.

A 72-year-old male is said to be in phase 2 of gout. He is obese and has a history of alcohol abuse. Develop a treatment plan including specific pharmacologic intervention

and a non-pharmacologic recommendation to manage his disease. - Correct

Answer Phase 2 of gout is acute gout arthritis. The goal of treatment in this phase is

to control inflammation and pain. Colchicine is a prescription drug that could be used to treat his acute inflammation. NSAIDS can also be used to treat inflammation and manage pain. This patient should be encouraged to lose weight and decrease his alcohol consumption. He should also avoid purine rich foods such as fish, bacon, and liver. (*Note - the student has to provide 1 pharmacologic intervention and 1 non- pharmacologic recommendation.) A patient has a bilateral presentation of pain in the PIP joints of the hands. You believe this pain is due to arthritis but are unsure whether it is a result of RA or OA. What are 3 questions you could ask this patient to help you differentiate between RA and OA? -

Correct Answer 1. Do you experience stiffness in the morning? 2. If so, does it

last less than or longer than 30 minutes? 3. Does prolonged movement aggravate or alleviate your symptoms? 4. Do you ever have periods of relief, or do you experience pain daily? 5. Did your pain start in both hands or did it start with one hand and develop in the other over time? 6. What is your profession? (occupations requiring repetitive movements often lead to OA) *Note - student only has to provide 3 questions.